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Name *

First Name

Last Name

Starting Dates *

MM

DD

YYYY

Insurance

We need confirmation that you have insurance for the duration of the program. Can you show us proof of insurance?

Yes

No

Liability release agreement

I declare that I have been duly informed as to the risks and dangers inherent with respect to the activities to which I will be exposed in different locations, which include agricultural practices, permaculture, walks, and talks that will be held at the different farms facilities, without being limited, and which could well include unforeseen or unknown risks due to their very nature. I confirm that during the time I am visiting the facilities, the tasks that I carry out and develop are under my responsibility, as well as due care and attention to the instructions given by the main guide and owner of the farm, which includes: 1. Guidance and accompaniment throughout the facilities, delimitation of health, safety, coexistence, and maintenance protocols of the facilities. 2. Food services provided and assumed by the administration of the Farms. 3. Detailed description of the activities carried out during the stay, as well as the setting of a schedule. 4. Hosting services. 5. Financial contribution is non-refundable. Likewise, I declare under oath that I do not have any illness or physical, mental or legal problem that prevents me from carrying out the activities that will take place during my stay at the different farms, and that, otherwise, I will inform the main guide and owner of the facilities in order for it to take the necessary measures. On my own behalf, I assume full responsibility for risks, damages, including personal and property, which may arise from participating in the activities promoted by Finca Cimarrón, Finca La Quimera, Finca Dalö Tsána, Finca Mandira. I freely declare and, aware of the legal consequences of my actions, in the condition in which I subscribe to this document, the following: That is my name I RELEASE Finca Cimarrón, Finca La Quimera, Finca Dalö Tsána, Finca Mandira, its members, agents and/or employees, other participants, and if applicable, any other third party involved, from all liability regarding incidents, which may lead to disability, death, loss or damage to person or property, whether due to negligence or other cause. I agree to release those released from all liability and obligation and from any claim or causes of a claim that I, my estate, heirs, survivors, executors, or assignees may have for personal injury, property damage, wrongful death as a result of the activities carried out in Finca Cimarrón, Finca La Quimera, Finca Dalö Tsána, Finca Mandira whether caused by the active or passive negligence of those exonerated, or by the causes contemplated in the Costa Rican regulations. If you do not feel comfortable or if none of the farms meet your expectations, we cannot make any refunds. However, we can place you in one of the other farms in the program. I HAVE READ THIS DISCLAIMER AND EXPRESS THE ASSUMPTION OF RISK AGREEMENT, UNDERSTAND THE TERMS IN THEIR ENTIRETY, AND UNDERSTAND THAT I HAVE WAIVED LEGAL RIGHTS BY SIGNING IT. I MANIFEST THAT I SIGN IT FREELY AND VOLUNTARILY.

I agree

I disagree